Healthcare Provider Details

I. General information

NPI: 1518911288
Provider Name (Legal Business Name): DANIEL H GRUENSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE MC 4051
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

5841 S MARYLAND AVE MC 4051
CHICAGO IL
60637-1447
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-6172
  • Fax: 773-702-2319
Mailing address:
  • Phone: 773-702-6172
  • Fax: 773-702-2319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number48460
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number48460
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: